25th National and 8th International Biostatistics Congress

TITLE *

NAME SURNAME *

YOUR TC ID NUMBER or PASSPORT NUMBER *

WORKING INSTITUTION *

LANDLINE PHONE NUMBER *

MOBILE PHONE NUMBER *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

E-MAIL ADDRESS *

REGISTRATION TYPE *

PARTICIPATION

SECOND PERSON STAYING IN THE SAME ROOM

NAME - SURNAME OF THE SECOND PERSON STAYING IN THE SAME ROOM* *

THIRD PERSON STAYING IN THE SAME ROOM

CHILD IN DOUBLE ROOM

CHILD'S NAME SURNAME *

CHILD'S DATE OF BIRTH *

NAME - SURNAME OF THE THIRD PERSON STAYING IN THE SAME ROOM *

REGISTRATION FEE ( EURO ) - FACULTY MEMBER / NOT AN ASSOCIATION MEMBER / SINGLE ROOM

REGISTRATION FEE ( EURO ) - FACULTY - RESEARCH ASSISTANT / SPECIALIST / NOT AN ASSOCIATION MEMBER / SINGLE ROOM

REGISTRATION FEE ( EURO ) - FACULTY MEMBER / NOT AN ASSOCIATION MEMBER / DOUBLE ROOM

REGISTRATION FEE ( EURO ) - FACULTY - RESEARCH ASSISTANT / SPECIALIST / NOT AN ASSOCIATION MEMBER / DOUBLE ROOM

REGISTRATION FEE ( EURO ) - ACCOMPANYING PERSON - DOUBLE ROOM

REGISTRATION FEE ( EURO ) - FACULTY MEMBER / NOT AN ASSOCIATION MEMBER / TRIPLE ROOM

REGISTRATION FEE ( EURO ) - FACULTY - RESEARCH ASSISTANT / SPECIALIST / NOT AN ASSOCIATION MEMBER / TRIPLE ROOM

REGISTRATION FEE ( EURO ) - ACCOMPANYING PERSON - TRIPLE ROOM

REGISTRATION FEE ( EURO ) - TOTAL FOR TWO ACCOMPANYING PERSONS - TRIPLE ROOM

REGISTRATION FEE ( EURO ) - CHILD

REGISTRATION FEE ( EURO ) - EXTERNAL PARTICIPANT

TOTAL ( EURO )

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Biostatistics Congress